Rationalising circumcision: from tradition to fashion,
from public health to individual freedom—critical notes
on cultural persistence of the practice of genital
mutilation

Received 24 March 2004
Revised version received
25 March 2004
Accepted for publication
25 March 2004

J Med Ethics
2004;30:248-253

Despite global and local attempts to end genital
mutilation, in their various forms, whether of males or
females, the practice has persisted throughout human
history in most parts of the world. Various medical,
scientific, hygienic, aesthetic, religious, and cultural
reasons have been used to justify it. In this symposium
on circumcision, against the background of the other
articles by Hutson, Short, and Viens, the practice is set
by the author within a wider, global context by
discussing a range of rationalisations used to support
different types of genital mutilation throughout time and
across the globe. It is argued that in most cases the
rationalisations invented to provide support for
continuing the practice of genital
mutilation—whether male or female—within
various cultural and religious settings have very little
to do with finding a critical and reflective moral
justification for these practices. In order to question
the ethical acceptability of the practice in its
non-therapeutic forms, we need to focus on child rights
protection.

Despite global and local attempts
to end genital mutilations, in their various forms, whether
of males or females, the practice has persisted throughout
human history in most parts of the world. Today both male and
female genital mutilation are particularly common in poor,
developing countries with wide traditional communities, but
these practices have also been maintained in many modern
Western multicultural societies. This is particularly the
case with male circumcision, which in many parts of the
Western world is still practised almost routinely, as the
articles by Hutson, Short, and Viens on the justification of
male circumcision in this journal, show.123

Short and Hutson focus more on scientific,
medical, and public health aspects while Viens discusses the
issue of religious freedom and identity. More precisely,
Hutson analyses whether the public health argument holds
water in justifying male circumcision as a routine operation
in relation to its health related consequences (whether these
are negative or positive). Short's commentary on Hutson
defends male circumcision on the basis of medical evidence
that the procedure (on males) has been scientifically proven
to improve both male and female reproductive health. Short
goes as far as suggesting that we might have some kind of
duty to develop better procedures to make the operation the
``kindest cut of all''. Viens, on the other hand, argues for
the justification of male circumcision on the basis of
individual freedom. Rather than speaking for the right of an
individual to make his or her own autonomous choices,
however, Viens draws his arguments from the parents' right to
decide what is best for their children as well as from the
parents' religious freedom to choose the (religious) identity
of, and for, their children. While Hutson is the most
hesitant of these three authors to defend the general
benefits of the operation, none of these articles directly
argues against male genital mutilation. While Viens is most
sensitive to religious freedom and cultural identity, none of
the authors discuss in detail the different cultural,
social,and economic contexts of these values and practices
across the globe. Instead, all the above mentioned authors
keep their discussion almost exclusively within the framework
of Western medicine and a pluralist society. While, albeit
briefly, supporting other cultures' rights to maintain their
religious identities, Viens is even willing to offer Western
assistance in developing less painful and medically safer
practices for the operation on children elsewhere in the
world. In this symposium, and against the background of the
articles by these three authors, I have taken it as my task
to set this discussion on the justification of male
circumcision within a wider, global context. I want to
discuss how we find a range of rationalisations to support
various types of genital mutilation and to evaluate whether
these rationalisations have anything to do with a critical
and reflective moral justification of these practices.

I shall pay attention to the following issues.
Firstly, I find it disturbing that even within the Western
medical community, there is evidently still a wide consensus
on such an intrusive and violent procedure as male
circumcision,albeit that this consensus is evidently based on
very different ``moral'' justifications, which vary from
public health, to scientific proof, to religion and to a
diversity of Western values. More worrying is the fact that
there appears to be a general agreement that this violent
procedure (as therapeutic and non-therapeutic one) can (and
according to Viens,even should) be carried out on infants
and/or very small children. In addition, male genital
mutilation (MGM) should not be considered in isolation from
the issue of female genital mutilation (FGM). In this
symposium only Viens recognises the existence of ``female
genital cutting''. He, however, regards it as part of the
same tradition which encourages MGM—that is, a
tradition based on religious freedom/cultural
identity—without making any attempt to distinguish the
different nature of the medical and moral reasons put forward
in favour of FGM.

Secondly, I find that both the medical and the
value based arguments presented by these three authors lack
either plausible evidence or logical consistency. Instead of
discussing each article separately, however, I shall describe
a wider global framework that provides false reasons in
defence of genital mutilation, rather than providing any
truly plausible moral justification for this practice.

RELIGIOUS FREEDOM, PAIN, AND
CHILDREN'S RIGHTS
Throughout history human beings have mutilated and harmed
their bodies (and minds)in the name of culture, tradition,
religion, and concepts of beauty, health, normality, or
social status. One of the most persistent forms of these
physical violations is mutilation of human genitalia. This
practice has been related to:taboos about human sexuality;
children's initiation to adulthood, maturity, and
reproductive age;aesthetic values; the demands set by various
religions, and to hygienic,individual,and public health
medical beliefs. (See the articles by Hutson, Short and Viens
in this journal, and also those by Aldeeb Abu-Salieh,Bigelow,
and by an anonymous author in Echo ).1–7 All in all, mutilation of
human sexual organs reflects our fears about human biological
needs—and even deeper fears about human sexual
needs—as well as fears to do with the maintenance of
established social hierarchies in a society.

In this symposium we are discussing the most
common form of genital mutilation, male circumcision. In its
mildest form, this means the cutting of the foreskin of the
penis. (For more detailed explanations see the articles by
Hutson, Short, and Viens).123 It is important to
note, however, that the same term, ``circumcision'' is also
used in relation to women's genital mutilation, where it
refers to the cutting of the tip or the whole of the
clitoris. There are, however, various other, more radical and
more harmful mutilations of human genitalia, which can be
relatively minor or extremely serious. Female genital
mutilation—for example, includes a wide range of ritual
and non-medical operations undertaken on women's genital
organs, which include their total or partial removal and
amputation or incisions in the interior of the vagina.
According to the World Health Organisation (WHO) female
genital mutilation can be classified into three major types:
type I or clitoridectomy—removal of the tip of the
clitoris; type II—cutting of the clitoris and all or
part of the labia minora, and type III or infibulation or
pharaonic circumcision, in which the clitoris is cut together
with part or the whole of the labia minora and incisions are
made on the labia majora. When this latter operation is
performed, the edges of the wound are often tied up again
leaving a small opening through which body liquids such as
urine or menstrual blood can flow. The resulting mass of scar
tissue which covers the urethra and the upper part of the
vagina, completely closes the vulva. If the opening is wide
enough, sexual intercourse may occur after a gradual
dilatation, which can take days, weeks or even months. When
the opening is too small to allow sexual intercourse, it must
be widened with a razor or knife on the wedding night. Given
the severity of cuts and stitches occurring during initial
and repeated interventions, infibulation is the most harmful
form of genital mutilation, both to reproductive health and
to health in general. Other practices which prevail in
certain countries of Central, Southern, and South Africa,
consist in pulling the labia and introducing substances and
minerals into the vagina to dry it and to increase men's
sexual pleasure (Anonymous,6 p
5). Male genital mutilation can vary from body piercing
through a range of various other modifications to
amputation,and castration.

While the moral justification for any type of
genital mutilation has been challenged from time to time, its
continuation for both men and women has been rationalised
over and over again via various medical,legal,moral,and
cultural arguments. The campaigns against MGM have not been
as vigorous as those against FGM since FGM is in general
considered to be a more violent and socially suppressive
practice than MGM. In addition FGM has more serious and
damaging physical, as well as psychological or social,
implications. On the other hand, the operation itself has no
medical justification, whereas a medical justification is
still put forward for MGM, as the articles by Hutson, Short,
and Viens show. Thus, male circumcision has been easier to
accept as a minor harm that can be justified, or at least
tolerated, if not sometimes encouraged (see Short's paper in
this journal) as a part of a particular religious or cultural
tradition or as a measure promoting individual or public
health.

In general, the arguments against MGM or FGM
claim that both practices violate the physical integrity of
children and cause avoidable pain. In the worst cases they
can lead to irreversible physical or psychological harm, as
noted by Huston in his contribution to this symposium. It
appears, however, that while neither, Hutson, Viens, nor
Short recommend male circumcision as a public health measure,
in individual cases they all accept male circumcision either
on medical or on religious grounds, as long as it does not
cause pain. Thus, they recommend better pain management
measures and more refined procedures to perform the
operation. This is particularly true of Viens's argument,
which defends, the practice in the name of religious freedom
but denies the fact that the operation is—or should
be—painful. This position appears to be contradictory,
since as a religious or cultural practice, the endurance of
pain is often an essential part of the ritual, showing the
readiness of individuals to transit from childhood to
adulthood, from boy to man, in the case of MGM, and from girl
to woman in the case of FGM. The other problem with Viens's
argument for religious freedom in relation to male
circumcision is that it supports male circumcision being
carried out on infants and small children at the request of
their parents, rather than waiting for the children to be
``old'' enough to give their ``informed consent'' and to
understand the real significance of the ritual and ``the need
to tolerate pain''.

From a human rights
perspective both male and female genital mutilation,
particularly when performed on infants or defenceless
small children,and for non-therapeutic reasons can be clearly
condemned as a violation of children's rights whether or not
they cause direct pain. Parents' rights cannot override
children's rights. If we allow parents to decide what
is best for their children on the basis of the children's
religious or cultural identity, we would have no
justification for stopping them cutting off their children's
ears, fingers, or noses if their religious and cultural
beliefs demanded this. Also, if we allow parents' rights to
override children's rights, we could not then forbid them
from making any other physical and spiritual sacrifices,
(such as ``cannibalism'' or ``human sacrifice'' as extreme
examples), particularly if we follow Viens's recommendation
and manage to develop techniques that minimise or abolish
pain.

TRADITION OF GENITAL MUTILATION AND
GENDER
This article focuses on male circumcision, but I do not want
to disregard the importance of mentioning female genital
mutilation in the same context. Some advocates of women's
rights who emphasise FGM as a sign of gender based violence
which springs from the patriarchal oppression of women, tend
to be reluctant to allow any comparison between male and
female genital mutilation and may disagree with my
comparisons.8 In this article,
however, parallels between FGM and MGM are drawn only in
respect of the implications of performing any potentially
harmful non-therapeutic, non-consensual procedure that in the
end is, in one way or another, a social issue rather than a
medical one. My purpose is not to diminish the ethical,
social, and medical dangers involved in FGM, but to widen the
scope of the discussion in this symposium. Focusing merely on
male circumcision—and leaving it almost exclusively
within a medical context—may make us forget that what
we are discussing here is a historical tendency to look for
rationalisations that allow us to practise genital mutilation
in one form or another, across geographical, cultural, and
religious boundaries.

I believe that examining the traditions of
genital mutilation from the point of view of both sexes may
reveal more clearly the irrationality involved in the
justifications that are made for continuing the practice of
mutilating human genitals. Thus, while there is a need to pay
special attention to the elements of social and political
oppression involved in FGM, it is also important to note that
throughout time men, as well as women, have learned to accept
that there are good reasons for the mutilations of human
genitalia. Usually these reasons raise false hopes that
undergoing the operation somehow improves people's
lives—and the lives of their children—whether
this be in the context of social status or of a medical
condition, while the true reasons for the practice may lie
elsewhere.

AUTONOMY V CULTURAL
RIGHTS—UNTANGLING THE DICHOTOMIES OF CULTURAL
TRADITIONS
When the justification of genital mutilation is
discussed,the disputes are usually tangled around issues
about the universality and relativity of our value systems,
and can often centre on the conflict between the different
rights that might be involved. In most cases, the debates for
and against genital mutilation are set within the framework
of collective cultural rights v individual rights. The
arguments against the practice of genital mutilation tend to
appeal to the promotion of individual autonomy and universal
human rights to various freedoms, while those who defend the
practice draw support for their claims from demands to
respect a person's particular cultural identity and/to
protect the rights of minorities,(minority cultures) as for
instance is argued by Veins.3
(See also Mills 910 and in connection with genital
mutilation my own paper of 1999.11)

In fact, Veins' argument further complicates
this debate between individualism and collectivism by
supporting male circumcision not only via an appeal to
(religious) freedom and identity as such, but also by
defending parents' rights to decide what is the best for
their children. He supports MGM further by going on to defend
our autonomy to decide what is our concept of the good life
and wellbeing, while simultaneously refuting children's
rights as not being real ``rights'' of autonomous and fully
rational persons. This sets ``autonomous'', ``adult'' rights
against children's rights. While children's rights tend to
create a problem for the defence of autonomy and informed
consent in general, Veins' view presents a rather
contradictory rationalisation for male genital mutilation by
championing parents' ``cultural identity'' against their
children's physical integrity. There is always a danger in
combining cultural and religious identity. The issue of
religion and religious identity in the context of culture is
in itself very complex: different cultures have different
influences on the interpretations of religious norms,
practices, and identities. Whether we talk about Islam,
Christianity, Hinduism or any other world religion, each is
followed very differently, depending on the original culture
and the historical changes that have affected it: Islam and
Christianity—for example, are practised very
differently in Saudi Arabia, in Uganda, and in the UK.

On the other hand, Veins' argument provides a
good example of how the dichotomy between individualism and
collectivism presents a rather black and white picture of the
cultural history of our world: individualism is tied
inseparably to universalism and the universal promotion of
human rights, while collectivist lifestyles are related
directly to relativism, which allows social suppression. This
polarisation of the positions simply overlooks the fact that
individualistic values and lifestyles can also fall into
relativist reasoning that rejects any interference with
individuals' ``autonomous'' choices. This position clearly
disregards the fact that most of our choices are made in a
social context and may often be influenced by social
pressures, or even by some refined forms of social
coercion.

Also, an individualist culture, in the name of
tolerance and freedom, may justify extremely violent and
irrational practices, and ``autonomous'' parents can ask for
their children to be physically mutilated in the name of
their preferred collective identity. Collectivist value
systems and cultural traditions, for their part, rely on a
universal demand for the protection of religious and/or
cultural rights and identities.1213

Reconsidering descriptive and prescriptive
senses of value systems can help us overcome normative
cultural dichotomies and to avoid culturally biased
discussions about genital mutilation and other harmful
practices. In order to curb injurious practices we need to
acknowledge that what makes some of these harmful customs so
persistent is the tendency to see them as essential,
integral, and identifying parts of particular cultures or
belief systems. If, however, we recognised openly that the
same or similar practices tend to appear
universally—that is, the same or similar practices
exist in one form or another in most parts of the world but
with different rationalisations—we could see more
easily the smokescreen that tends to blur moral argumentation
around these practices. The best way to curtail any harmful
and violent custom is to find a way to raise resistance to it
within the communities themselves,by revealing the
irrationality and dishonesty of the reasons put forward to
maintain such customs as genital mutilation, and so their
irrelevance to any cultural identity.

MEN AND CIRCUMCISION IN THE
``WILD'' WEST
Arguing about conflicting rights and cultural identities may
lead us astray, if we do not invalidate some of the central
fallacies that persist as part of the rationalisation process
of genital mutilation. Firstly, if we are to have a serious
``moral debate'' on the persistent existence of genital
mutilation, we need to recognise the various rationalisations
used to defend it throughout human history,not merely in any
particular time or age. Secondly, we need to further evaluate
these rationalisations to see how they are successfully
shaped to fit their local traditions and social
environments.In most cases, these rationalisations are full
of inconsistencies and act as a mere smokescreen to cover up
the actual social, political, or economic reasons that are
behind the preservation of genital mutilation in any given
cultural context. Thirdly, recognising the complexity of the
cultural and ethical issues involved in the justification
process of genital mutilation may help us to find new ways to
get rid off the false reasons for the practice and better
ways to combat this violent practice worldwide.

Since the practice of genital mutilation has
existed in almost all known civilisations at some time or
another in various forms, we cannot say genital mutilation is
a tradition that is unique to a particular culture or
religion as such; and therefore we cannot say that defending
the practice means defending the right of that culture to
exist and defending the rights of its members to maintain
their cultural identities. Since genital mutilation has
appeared in a number of cultures and is related to various
belief systems, it is not important whether these cultures or
belief systems themselves are (more) individualist or (more)
collectivist in their value structure: what is important is
to pay more attention to the differences in the types of
rationalisation put forward to support them within different
types of cultural frameworks. In most cases it appears that
whether the practice withers away or remains an integral part
of that culture's identity, depends on the strength of the
rationalisations and the availability of education in that
culture.

Since genital mutilation is not alien to
individualist cultures, we can look at the medical
rationalisation of male circumcision in the Western
individualist tradition. Within Western medical history
cutting off or extracting the male foreskin has been believed
to cure insanity, masturbation, epilepsy, cancer of the
penis, and even cancer of the cervix of the future wives of
the circumcised boys as well as sexually transmitted diseases
and particularly phimosis (either as a disease or as a
cause of other diseases such as cancer). Even today the
relation between male circumcision and HIV/AIDS is still
extensively studied and debated,as the articles by Hutson,
Short, and Viens show.123 In particular, the
claim that male circumcision is able in fact to prevent
HIV/AIDS, can have negative consequences,especially in parts
of the world where medical hygiene is poor and/or relevant
health education is not readily available.

The claim that being circumcised helps to
prevent HIV/ AIDS may in fact lead to triple jeopardy in the
fight against AIDS. Firstly, where there is a lack of medical
facilities for the operation the knives and other utensils
used for the procedure might actually fuel the spread of
AIDS. This further complicates Viens's argument for religious
freedom, because he also recommends that the operation be
carried out in modern medical facilities with more advance
pain management. If this requirement is set in a global
context, a logical, but nevertheless contradictory,
consequence would be, that (male or female) circumcision
should be allowed in the name of religion only in those parts
of the world were hygiene and advanced medical treatments and
technology are readily available. From the point of view of
religious freedom this is a rather restrictive
requirement.

Secondly, the fact that people believe they are
somehow protected against HIV by being circumcised may cause
them to be somewhat careless or dismissive about the need for
other protection, to have promiscuous sex, and in general to
feel they are now immune to the virus. Thirdly, the fact that
male circumcision is seen to be medically related to the
prevention of HIV/AIDS may lead onto a slippery slope that
ultimately leads to it being culturally required that FGM is
practised for the same purpose. This would be even more
counterproductive, since there is medical evidence that women
are more vulnerable to the virus to start with. Whatever
medical indication there might be that male circumcision
actually prevents the spread of HIV/AIDS, the effect of this
in stopping the spread of the virus would be undermined if,
as a result, more women were infected because of unsafe, and
maybe also forced, sex.

All this shows that while opinions about the
diseases that male circumcision is to be used to prevent or
to cure have changed throughout time, male circumcision as
such has persistently maintained its place as a medically
justifiable practice in Western countries, and is gaining
further justification as the papers by Hutson, Short, and
Viens show. In addition, male circumcision has also had a
longstanding religious rationalisation in the Western
cultural context within Judaism, Islam, and even
Christianity, as explicated by Viens; it has medical
rationalisation to the level of being almost routinely
practised in the United States and in Australia, as discussed
by Hutson and Short; and in most cases it has an individual
justification which is based on alleged medical conditions,
as noted by Short. The medicalisation of this operation in
the West has given the practice a stronger ``rational''
justification in a modern society than even traditional and
religious demands can provide.14151617

Whether the rationalisations of genital
mutilation are cultural, aesthetic, religious, hygienic,
medical, or scientific, the truth behind the practice of
genital mutilation might still be a very different story.
Even a medical rationalisation may cover up other more hidden
purposes. If we compare the persistent continuation of male
circumcision in the United States with the same phenomenon in
Europe we find rather interesting results. The studies by
Fletcher,14 and Fleiss18 show how in the United States, where
the routine circumcision of newborn males has been common
until rather recently, because of the widespread diffusion of
the scientific myths about its benefits, the medical data
with counter results were deliberately ignored or
misinterpreted in order to maintain the practice. For
instance, the latest reports from European medical research
on the issue were neglected in order to maintain the practice
in the USA even when it was already rapidly disappearing in
Europe, as also noted by Hutson.1 Behind the disguise of alleged medical
benefits we can find more gruesome reasons for the
maintenance of the practice. In a modern, American, market
oriented society male circumcision became a form of
commercial exploitation of children when physicians, in
cooperation with transnational biotechnology corporations,
looked for the sales of marketable and economically
profitable products made from harvested human foreskins that
could further be used in the pharmaceutical industry
(Fletcher,14 pp 259–71),
(Sorrells,15 pp
331–7).17

MALE CIRCUMCISION IN AFRICA AND
BEYOND
The practice of genital mutilation plays a central role in
social hierarchies and personal relationships (not only
between the different genders, but also between men
themselves and between women themselves). Whether the
rationalisation for male circumcision is a religious,
cultural, medical or hygienic one, those men who remain
uncircumcised in the societies in which the practice is
common, are made to feel somehow abnormal and/or not equal to
those who have undergone the operation. Just to take a few
local examples: in East Africa, for instance, men of the
Masai tribe see uncircumcised men as adolescent, spineless,
and timid cowards who do not have full male qualifications
(whether we talk about the uncircumcised men of their own
community, or those of other tribes or races). Within the
Cameroonian Nso tribe the three main rationalisations for
male circumcision have been firstly, the belief that
circumcision prepares the penis, puts it in a state of
readiness for coitus and procreation, secondly that it tests
the courage and endurance of a boy at the threshold of
adulthood, and thirdly, but rather in contradiction of the
first claim, it is thought to tame and moderate the sexual
instinct thereby helping a man to act more
responsibly.19

The Tanzanian Chagga tribe, for its part,
circumcises young boys in different age groups (thus the age
for circumcision may vary from 4 to 18). In cases where the
circumcision is postponed for a long time, for one reason or
another, by the parents and relatives, many of the boys seek
a way to go through the operation on their own, endurance of
pain being a central element of the ritual. Before having the
operation done to them they feel socially and physically
immature. With the modern Chagga, many of whom are now
Catholics by religion, the rationalisation for circumcision
is nowadays hygienic rather than traditional. The Islamic
Chagga, for their part, can appeal to the demands of their
religion, for circumcision. In reality, however, the practice
is clearly based on peer pressure and the community's social
expectations. Uncircumcised men in many African communities
are seen as undeveloped or ``child like'' and are thought to
be inclined to poor sexual or reproductive performance.

Social pressures are also typical in the
societies in which the rationalisation is more purely based
on religious demands. It may seem inconsistent to require
genital mutilation on a religious basis since this is
perfecting the work of God by cutting off,modifying or
redesigning any part of a human body which has been created
by God. The human ability to find the needed false reasons,
however, is boundless; in the case of genital mutilation the
attempt to reduce sexual pleasure and to maintain chastity is
seen not only as an improvement of God's work, but also as
showing obedience to whatever is believed and interpreted to
be God's will in any given culture. In traditional Judaism,
for instance, male circumcision is a means to moderate the
sexual pleasure of men and their attraction to women. Similar
views, to do with reducing the sexual pleasure rather than
fully suppressing it, have been presented in Islam. In Islam
the argument linking pleasure to circumcision, however, is
used more frequently in the case of female genital
mutilation. In most religions (as for Jews and Muslims)
circumcision is also a mark that distinguishes the believer
from the non-believer. The fact that circumcision has,
throughout history, been practised also within traditional
belief systems—for example, by Australian Aborigines,
the Mayas of Borneo, various Native American tribes, the
ancient Aztecs and Mayas, etc—is not taken as
undermining the claim that this practice is seen as a sign
that distinguishes a believer from a non-believer in such
world religions as Islam or Judaism.4520–23 In
general then when the justification of genital mutilation is
based on traditional or religious grounds, whether in Arab,
Eastern, Western or Southern cultures, the emphasis has been
on God's will as well as the purity of body and mind.

All in all, the inconsistencies between sexual
performance and religious identity in relation to genital
mutilation do not seem to reduce the power of the false
reasons put forward to support the practice. In some cultures
circumcision is justified as a means to control men's and
women's sexual desires, while in others it is used for
precisely the opposite purpose, that is to prove the sexual
virility and endurance of men. In yet other cultures it is
used to enforce traditional and natural cultural identity and
social order, and in others it is used to mark religious
affiliation and God's will.

FEMALE GENITAL MUTILATION AND
GENDER EQUALITY
Female genital mutilation, for its part, is usually seen as
part of traditional and collectivist cultures with
patriarchal social structures. It is not, however, fully
alien to the more individualist Western cultural tradition.
Female genital mutilation used to be practised in Western
civilisations as a cure for various medical conditions while
the actual social reasons for its maintenance may have lain
elsewhere in Western history. Clitoridectomy was, for
instance, used both in Europe and in America for hygienic
reasons, as a medical cure for masturbation, and for mental
disorders such as hysteria. Since in the West both male and
female circumcision were practised by qualified doctors for
allegedly legitimate medical indications, they were not
considered to be the same brutal and intervening mutilations
of the human body as they were seen to be elsewhere in so
called ``more primitive'' societies. This shows that science
can be a double edged sword that readily lends itself as an
alibi for strongly held preferences and cultural biases. In
particular, the medicalised nature of the Western culture
itself can give legitimisation to even violent and
unnecessary physical interventions on the human body in the
name of science, progress, normality, and health while the
actual reasons for such interventions may remain
hidden.11

Today, female genital mutilation, now called
traditional circumcision, no longer exists openly in the
Western cultural mainstream, but it persists in the
developing world. With the relatively recent emphasis on
pluralist values, tolerance, and respect for personal
autonomy, however, practices of genital mutilations have
recurred in the West. Body piercing and other rather
extremist forms of sexual (pleasure seeking) subcultural
practices have introduced new, less openly condemned, forms
of genital mutilation. These contemporary forms of genital
mutilation are taken to be more acceptable since they are
thought to have come about as a result of one's autonomous
choice and free will. Thus, the main ethical battle against
genital mutilation in Western culture still focuses more on
preventing the traditional forms of FGM, which also is
practised (though mostly in secret) within various immigrant
communities in multicultural Western societies. Here again,
we can note that the culture itself introduces the same
practice (in different forms) over and over again,succeeding
always in finding a culturally fitting justification for it,
while being simultaneously more than ready to reject the same
or similar custom in other cultures.824

While, however, many traditional communities
where FGM is practised remain clearly more patriarchal and
use female genital mutilation to control women's sexual
behaviour, economic factors should not be ignored. Those
performing the operation earn a good income out of it and
thus, the practice provides livelihoods for many. Also,
circumcised girls guarantee better bride prices and higher
social status for their families. This may help us to
understand why not only men, but also women themselves, while
victims of the practice of FGM, are often its strongest
proponents. It is true that the more traditional types of
female genital mutilation clearly have more devastating
medical consequences for their victims, particularly in poor
environments and in unhygienic conditions. In addition, they
are usually performed on vulnerable and defenceless children.
Thus, evidently there is an urgent need to find a ways to
curtail the practice. Additionally, as noted, female genital
mutilation tends to persist in societies that have a more
traditional, a more patriarchal social structure, thus its
maintenance is more directly related to the low social status
of women. Female genital mutilation in traditional
environments is said to be harder to combat, since its
persistent maintenance is usually based on women's lack of
education and decision making power in their communities.
Thus, the abolition of FGM is not merely in hands of its
direct victims. It is also in the hands of the society as a
whole, and particularly in the hands of those in social and
political or religious power. Power relations between the
sexes, however, are difficult to change and thus, the
practice persists and is justified in a manner that makes
women themselves adopt it as a part of their cultural
identity and of their social pride through history. In
Africa, for instance, the history of female genital
mutilation dates back to 4000 years BC. Even today in Africa
FGM is still practised in at least 27 countries and every
year two million girls at least are exposed to sexual
mutilation. These mutilations constitute one aspect of a
series of traditional practices harmful to women's health and
welfare—that is,forced marriages and early pregnancies,
force feeding, tattooing, scarification, and nutritional
taboos. Also, although some people consider the practice of
FGM to be recommended by Islam, Christianity, and traditional
religions, there are non-believers who practise this as well.
These practices are also found in Egypt as well as in the
majority of Arab Muslim countries of the Middle and Near East
as well as in Islamic societies in the Far East.6825 Finally, it should not be overlooked
that women are also involved in the maintenance of male
genital mutilation.In the case of MGM, setting aside
religious or traditional rationalisations or social pressures
from the community, women (those who themselves have not
undergone any genital mutilation, as in the US—for
example) may prefer circumcised men as sexual partners,
either because their performance in sexual intercourse lasts
longer or because they consider a circumcised penis to be
more hygienic and/or more aesthetic than an uncircumcised
one.

CONCLUSION
Human sexuality and the attempts to control it, particularly
to reduce or add sexual pleasure, have been, in one way or
another, a part of all known cultures and civilisations.
While sometimes this fact is acknowledged openly as the main
purpose for genital mutilation, in most cases other
rationalisations are put forward for the practice. These
false reasons have varied from religious and cultural demands
to a number of medical ``explanations'', depending on the
wider cultural tradition within which the practice has
appeared. These different rationalisations for the
maintenance of the practices in various cultures show that no
matter what the cultural differences are in beliefs and
lifestyles, genital mutilation is a universal sign of human
civilisation—or maybe the lack of it. All societies
have found the arguments that best fit their local cultural
traditions and environments in order to introduce or maintain
genital mutilation in its various forms. In the Western,
rather individualist tradition, these rationalisations are
based on benefit to the individual and/or autonomy; in the
Southern and Eastern cultures their support is drawn more
directly from social values and ties, or from the need to
protect one's unique cultural identity against Western
cultural imperialism. Thus, in this regard one cultural
tradition cannot be said to be better than another. Rather,
with further education and knowledge the cultural smokescreen
around the real reasons for the maintenance of the practice
can be overcome in all societies no matter what their
cultural background.

Hellston SK. Rationalising circumcision:
from tradition to fashion, from public health to individual
freedom—critical notes on cultural persistence of the
practice of genital mutilation. J Med Ethics
2004;30:248-53.